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I thank Isaac J. Kirstein, DO, for his thoughtful comments about the September 2006 JAOA article I cowrote with Mrs Louder.1 Dr Kirstein is correct to point out that the cohort was composed entirely of students enrolled at A.T. Still University-Kirksville College of Osteopathic Medicine in Mo. I briefly reviewed the medical literature on the effects of curriculum on standardized testing and could find little support for arguing that curriculum plays a significant role in outcomes.2 Though I suppose a different curricular approach might have resulted in different outcomes, I doubt that theory. I encourage an ambitious reader to seek an answer to the question Dr Kirstein's letter suggests.

Dr Kirstein also argues that the formula Mrs Louder and I created has little “effect on removing selection bias against COM [college of osteopathic medicine] graduates.” I agree. That was not the intended goal of our study. What the study does provide, however, is a gauge that program directors at residency programs accredited by the Accreditation Council for Graduate Medical Education can use to make reasonable comparisons if they are otherwise impressed with an osteopathically trained candidate. Our study was not intended to answer any of the larger questions Dr Kirstein rightly poses.